The effects of processing barley and maize on metabolic and digestive responses in horses.

The competition for customers increases the search for new grain processing methods for equine feed, but the effect on starch digestibility and metabolic responses varies. Therefore, to evaluate the effect of the processing methods, toasting and micronizing, on starch digestion and the effect on metabolic responses, the mobile bag technique (MBT) and plasma glucose and insulin concentrations in the blood were used to estimate nutrient disappearance and metabolic responses pre-cecally. Further, cecal pH, ammonium nitrogen (N), and short-chain fatty acid (SCFA) concentrations were used to estimate the metabolic response in the cecum. Four cecally cannulated horses (body weight [BW] 565 ± 35 kg) were used in a 4 × 4 Latin square design with four periods of 8 d of diet adaptation and 2 d of data collection. Diets were formulated using hay and processed grains: micronized barley (MB), toasted barley (TB), micronized maize (MM), and toasted maize (TM) and were balanced to provide 1 g starch/kg BW in the morning meal. On day 9 in each period, blood and cecal fluid samples were taken before the morning meal and hourly thereafter for 8 h. On day 10 in each period, 15 bags of either MB, TB, MM, or TM (1 × 1 × 12 cm; 15 µm pore size; 1 g feed) were placed in the stomach, respectively. The dry matter disappearance was highest for the MM at all time points compared with the other feedstuffs (P < 0.001). Maize and micronizing had the highest starch disappearance (P = 0.048) compared with barley and toasting. No treatment effect was measured for any of the glucose and insulin parameters. No feed effect was measured for the insulin parameters. Plasma glucose peaked later (P = 0.045) for maize than for barley, and TB had a larger area under the curve for glucose than MB, MM, and TM (P = 0.015). The concentration of total SCFA increased after feeding (P < 0.001), with a higher concentration for barley than for maize (P = 0.044). No treatment or feed effects were measured for ammonium N or pH, but both were affected by time (P < 0.001). In conclusion, toasting was not as efficient as micronizing to improve pre-cecal starch digestibility; therefore, the preferred processing method for both barley and maize is micronizing. Further, the amount of starch escaping enzymatical digestion in the small intestine was higher than expected.

Economic Impact of the Use of an Absorbable Adhesion Barrier in Preventing Adhesions Following Open Gynecologic Surgeries.

We used an economic model to assess the impact of using the GYNECARE INTERCEED absorbable adhesion barrier for reducing the incidence of postoperative adhesions in open surgical gynecologic procedures. Caesarean section surgery, hysterectomy, myomectomy, ovarian surgery, tubal surgery, and endometriosis surgery were modeled with and without the use of GYNECARE INTERCEED absorbable adhesion barrier. Incremental GYNECARE INTERCEED absorbable adhesion barrier material costs, medical costs arising from complications, and adhesion-related readmissions were considered. GYNECARE INTERCEED absorbable adhesion barrier use was assumed in 75% of all procedures. The economic impact was reported during a 3-year period from a United States hospital perspective. Assuming 100 gynecologic surgeries of each type and an average of one GYNECARE INTERCEED absorbable adhesion barrier sheet per surgery, a net savings of $540,823 with GYNECARE INTERCEED absorbable adhesion barrier during 3 years is estimated. In addition, GYNECARE INTERCEED absorbable adhesion barrier use resulted in 62 fewer cases of patients developing adhesions. Although the use of GYNECARE INTERCEED absorbable adhesion barrier added $137,250 in material costs, this was completely offset by the reduction in length of stay ($178,766 savings), fewer adhesion-related readmissions ($458,220 savings), and operating room cost ($41,078 savings). Adoption of the GYNECARE INTERCEED absorbable adhesion barrier for appropriate gynecologic surgeries would likely result in significant savings for hospitals, driven primarily by clinical patient benefits in terms of decreased length of stay and adhesion-related readmissions.

Cosmetic outcome and surgical site infection rates of antibacterial absorbable (Polyglactin 910) suture compared to Chinese silk suture in breast cancer surgery: a randomized pilot research.

BACKGROUND: The primary objective of this multicenter post-market study was to compare the cosmetic outcome of triclosan-coated VICRYL Plus sutures with Chinese silk sutures for skin closure of modified radical mastectomy. A secondary objective was to assess the incidence of surgical site infection (SSI). METHODS: Patients undergoing modified radical mastectomy were randomly assigned to coated VICRYL Plus antibacterial (Polyglactin 910) suture or Chinese silk suture. Cosmetic outcomes were evaluated postoperatively at days 12 (± 2) and 30 (± 5), and the evidence of SSI was assessed at days 3, 5, 7, 12 (± 2), 30 (± 5), and 90 (± 7). Cosmetic outcomes were independently assessed via visual analogue scale (VAS) score evaluations of blinded incision photographs (primary endpoint) and surgeon-assessed modified Hollander Scale (mHCS) scores (secondary endpoint). SSI assessments used both CDC criteria and ASEPSIS scores. RESULTS: Six Chinese hospitals randomized 101 women undergoing modified radical mastectomy to closure with coated VICRYL Plus suture (n = 51) or Chinese silk suture (n = 50). Mean VAS cosmetic outcome scores for antibacterial suture (67.2) were better than for Chinese silk (45.4) at day 30 (P < 0.0001)). Mean mHCS cosmetic outcome total scores, were also higher for antibacterial suture (5.7) than for Chinese silk (5.0) at day 30 (P = 0.002). CONCLUSIONS: Patients using coated VICRYL Plus suture had significantly better cosmetic outcomes than those with Chinese silk sutures. Patients using coated VICRYL Plus suture had a lower SSI incidence compared to the Chinese silk sutures, although the difference did not reach statistical significance.